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Prognostic implications of emergency department determination of B-type natriuretic peptide in patients with acute heart failure: the PICASU-2 study

Miró O, Jacob J, Martín-Sánchez FJ, Herrero P, Pavón J, Pérez-Durá MJ, Noval A, Segura F, Richard F, Giménez A, Gil C, Alonso H, Ruiz M, Garrido M, Gil Román JJ, Aguirre A, Manuel Torres J, Ruiz F, Perelló R, Villena H, Gil V, Llorens P

Grupo de Investigaci√≥n en Insuficiencia Cardiaca Aguda de la Sociedad Espa√Īola de Medicina de Urgencias y Emergencias (ICA-SEMES). Spain. √Ārea de Urgencias, Hospital Cl√≠nic. Barcelona, Spain. Grupo de Investigaci√≥n 'Urgencias: Procesos y Patolog√≠as', IDIB

Objective: To investigate whether hospital emergency department measurement of Btype
natriuretic peptide (BNP) in patients with acute heart failure is beneficial in terms of
patient outcomes and according to hospital category (availability or not of BNP testing
in the emergency department).
Method: PICASU-2 is an analytical multicenter retrospective study of patients with acute
heart failure according to the Framingham criteria, with follow-up of cohorts. Baseline
Data and data pertaining to each acute heart failure episode were collected. Outcome
measures were in-hospital mortality, 30-day mortality, and revisits to the emergency
department within 30 days. Cases were classified as having a record of BNP measurement
or not. Hospital emergency departments were classified as not having the resources for
emergency BNP measurement (type A hospital), having the possibility of testing
selectively (type B), and testing for BNP more generally (>50% of patients) (type C).
Results: Nineteen hospital emergency departments contributed data on 2423 patients,
32.4% of whom had BNP measurements; by hospital category, 34.7% of the patients
were from type A facilities, 34.6% were from type B, and 30.7% were from type C. Inhospital
mortality was 7.2%, 30-day mortality was 8.1%, and 24% of the patients
revisited within 30 days. Neither the measurement of BNP nor the fact of BNP
measurement availability in the emergency department was associated with a better
clinical outcome. Likewise no significant associations were found after adjustment for
patient status in stable condition or characteristics of the acute episode. When patients
who were discharged directly from the emergency department were analyzed separately,
again no associations with outcomes were found.
Conclusion: In the absence of a well-established protocol for managing episodes of
acute heart failure according to BNP levels, emergency measurement of this peptide
does not seem to contribute to improving outcome for these patients.

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